Stomach pain

[Badrabbit]

I have had Stomach pain for over 5 weeks now, I have been to the Hospital many times, 2 CT scans with contrast, blood test, Urine test, X Ray's etc everything comes back clear, now the Dr has given me 2 months worth of RABEPRAZOLE SANDOZ TABLETS, 2 months of (B)FAMOTIDINE 20 MG, DEANXIT TAB/flupentixol+militiamen tabs, I don't think they are doing anything, what do I do to find out what my problem is?

This is getting me down so much,  do I go for an Endoscopy which I'm very scared about.

Any advice would be much appreciated. 

[bkk6060]

I have had similar and took antibiotics for a few weeks and it went away.

So, what they gave you will treat the symptoms but not if it is an infection.

If it were me I would try the antibiotics for a stomach infection.

But, maybe go back to the Doctor and ask.

[Badrabbit]

2 minutes ago, bkk6060 said:

I have had similar and took antibiotics for a few weeks and it went away.

So, what they gave you will treat the symptoms but not if it is an infection.

If it were me I would try the antibiotics for a stomach infection.

But, maybe go back to the Doctor and ask.

I had a Stool test which showed no Infection plus blood and Urine test clear, I don't know what to do next.

[Will B Good]

You could have the endoscope done under a general...........worth it to put your mind at rest.

 

Also, God forbid, if they find anything suspicious they can do a biopsy.

[Upnotover]

13 minutes ago, Badrabbit said:

do I go for an Endoscopy which I'm very scared about

The procedure is nothing to be scared about, I had one last weekend and even without sedative, just a throat spray, it's perfectly bearable, with sedative it's hardly noticeable at all as my first was but this time I had to drive home afterwards.

[KhunLA]

2 minutes ago, Will B Good said:

You could have the endoscope done under a general...........worth it to put your mind at rest.

 

Also, God forbid, if they find anything suspicious they can do a biopsy.

While at it, get a colonoscopy, as may be a problem in your upper tract of intestines, close to your stomach.

[Badrabbit]

1 minute ago, Will B Good said:

You could have the endoscope done under a general...........worth it to put your mind at rest.

 

Also, God forbid, if they find anything suspicious they can do a biopsy.

Ct scans showed nothing, Dr said there is nothing wrong with you that is life threatening, pain started with burning plus pain so Reflux was suggested by me, so I guess Endoscopy is the next expensive test which I'm sure will show nothing.

[Badrabbit]

3 minutes ago, Upnotover said:

The procedure is nothing to be scared about, I had one last weekend and even without sedative, just a throat spray, it's perfectly bearable, with sedative it's hardly noticeable at all as my first was but this time I had to drive home afterwards.

Why did you have one and what does it show?

[Will B Good]

7 minutes ago, Badrabbit said:

Ct scans showed nothing, Dr said there is nothing wrong with you that is life threatening, pain started with burning plus pain so Reflux was suggested by me, so I guess Endoscopy is the next expensive test which I'm sure will show nothing.

I suffered with severe pain due to reflux.

 

I was prescribed a PPI and the pain stopped with 24 hours.

 

Been on them for 12 years now.

[Upnotover]

5 minutes ago, Badrabbit said:

Why did you have one and what does it show?

I had suspected upper GI bleeding.  The stomach inspection found erythematous gastritis (inflammation) and an ulcer.  6 weeks on Omeprazole and the ulcer has gone and the gastritis is improved.

[Badrabbit]

8 minutes ago, Will B Good said:

I suffered with severe pain due to reflux.

 

I was prescribed a PPI and the pain stopped with 24 hours.

 

Been on them for 12 years now.

What are the PPI called? 

[Badrabbit]

9 minutes ago, Upnotover said:

I had suspected upper GI bleeding.  The stomach inspection found erythematous gastritis (inflammation) and an ulcer.  6 weeks on Omeprazole and the ulcer has gone and the gastritis is improved.

Maybe I should take Omeprazole as I think it is Acid Reflux.

[Sheryl]

12 minutes ago, Badrabbit said:

What are the PPI called? 

You are already on a PPI. The RABEPRAZOLE  is a PPI.

 

Nothing at all to be gained by switching to omeprazole (though it will be less expensive).

 

In addition to already being in a PPI you are also already on a Histamine H₂ receptor antagonist (Famotidine) which also decreases stomach acidity.

 

In short you are already on maximal medical therapy to decrease acid secretion. If the pain you were having was due to reflux you would have felt better very quickly. That you have not, suggests the problem is something different.

 

If the pain is indeed gastric in origin then an endoscopy would indeed be the next step. This will show if, for example, you have inflammation of the stomach lining (gastritis) or ulcers.

 

But before proceeding to that please describe exactly where the pain is, as I find that people often say "stomach pain" for pain that is actually elsewhere in the abdomen.

 

Also please indicate where/ by whom you are being treated.

 

 

 

[Badrabbit]

5 minutes ago, Sheryl said:

You are already on a PPI. The RABEPRAZOLE  is a PPI.

 

Nothing at all to be gained by switching to omeprazole (though it will be less expensive).

 

In addition to already being in a PPIU you are also already on a Histamine H₂ receptor antagonist (Famotidine) which also decreases stomach acidity.

 

In short you are alrewady on maximal medical therapy to decrease acid secretion. If the pain you were having was due to reflux you would have felt better very quickly. That yopu have not, suggests the problem is something different.

 

If the pain is indeed gastric in origin then an endoscopy would indeed be the next step. This will show if, for example, you have inflammation of the stomach lining (gastritis) or ulcers.

 

But before proceeding to that please describe exactly where the pain is, as I find that people often say "stomach pain" for pain that is actually elsewhere in the abdomen.

 

Also please indicate where/ by whom oyu are being treated.

 

 

 

The pain is all around my belly button, seeing Dr at Mission Hospital Phuket.

Sometimes the pain goes to my chest but goes fairly quickly.

[Will B Good]

23 minutes ago, Badrabbit said:

What are the PPI called? 

Omeprazol is one of the most common ones.

[Badrabbit]

1 minute ago, Will B Good said:

Omeprazol is one of the most common ones.

Thanks, I've got those and so much cheaper than what the Hospital gave me 3000bht for 2 months, Ome 70bht for a box of maybe 20 tabs.

[rott]

52 minutes ago, Will B Good said:

I suffered with severe pain due to reflux.

 

I was prescribed a PPI and the pain stopped with 24 hours.

 

Been on them for 12 years now.

Same same. 

[sqwakvfr]

All these scans are great diagnostic tools but the only true way to diagnose the problem in the stomach, esaphagus, and small intestine is an endoscopy..  I've had 4 endoscopies in the last 10 years.  All have been painless.

 

Your symptoms indicate it could be Gastritis(stomach lining inflammation) or possibly an H Pylori infection.  

 

 

 

 

[Sheryl]

1 minute ago, Badrabbit said:

The pain is all around my belly button, seeing Dr at Mission Hospital Phuket.

That in no way suggests reflux.

 

It is also not properly described as "stomach" pain, it is abdominal pain (periumbilical abdominal pain, to be exact).

 

While this region is not near your stomach, sometimes gastritis pain is referred there, however in that the case there should usually have been some symptomatic relief from the meds you are on. Even though gastritis takes time to heal, reduction in gastric acid should lessen the pain. However an active ulcer i nthe stomach or duodenum might still be painful even on meds, and endoscopy is the best way to exclude this.

 

Other possible causes include :

 

Appendicitis, but if it were that your white blood count should be (or become) elevated. How long ago was the blood test? Might be worth repeating it.  Also, should have shown  on CT.

 

Pancreatitis (would be chronic not acute as otherwise you'd be much sicker) - regular CTs can sometimes miss this especially if done early in the disease.  Do you know if serum amylase and lipase were tested (and if so, how long ago?). And how long ago were the CTs?

 

Gall bladder issues (stones, inflammation) can sometimes cause pain in this location but if so would expect to have been visible on CT.

 

A problem with the mesenteric artery causing restricted blood flow - as you are not critically ill, would be of the chronic type. CT will often  miss this , especially if the radiologist was not specifically looking for it.  This is less likely as a cause but can't be totally ruled out as a cause.

 

In terms of what to do, I would suggest proceeding with the endoscopy but to discuss first with the doctor whether it might be wise to make it an endoscopic retrograde cholangiopancreatography (ERCP) which is a type of endoscopy better able to identify chronic inflammation of the pancreas.

 

If this fails you would best come to Bangkok, bringing all test results with you (including the imaging on disk) and see this US-trained, US-board certified doctor who is tops in the field:

 

https://www.bumrungrad.com/en/doctors/Parit-Mekaroonkamol

 

You could also come and see him now, but if he then felt endoscopy was needed, it would cost much more to have it done at Burmungrad than it will at Mission.

 

 

 

 

[Sheryl]

2 minutes ago, sqwakvfr said:

All these scans are great diagnostic tools but the only true way to diagnose the problem in the stomach, esaphagus, and small intestine is an endoscopy..  I've had 4 endoscopies in the last 10 years.  All have been painless.

 

Your symptoms indicate it could be Gastritis(stomach lining inflammation) or possibly an H Pylori infection.  

 

 

 

 

H. Pylori has apparently already been ruled out. And as he is already on heavy duty anti-secretarory meds, pain due to gastritis should have improved yet apparently has not.

 

Ulcer is possible, so is chronic pancreatitis and some other things.

[Sheryl]

24 minutes ago, Badrabbit said:

Thanks, I've got those and so much cheaper than what the Hospital gave me 3000bht for 2 months, Ome 70bht for a box of maybe 20 tabs.

The meds you are already on already include a PPI. Do nto add omeprazole when you are already taking rabeprazole. Same class of medication, same action. And from what you say, not helping.

[it is what it is]

if i were you i'd definitely want to know what's going on inside, five weeks is already a long time to wait. the UK NHS (national health service) site is excellent for information and advice;

 

https://www.nhs.uk/conditions/stomach-ache/

[Mavideol]

1 hour ago, Upnotover said:

The procedure is nothing to be scared about, I had one last weekend and even without sedative, just a throat spray, it's perfectly bearable, with sedative it's hardly noticeable at all as my first was but this time I had to drive home afterwards.

agree, nothing to worry about, had similar symptoms as the OP, did endoscopy,  just mouth/throat spray as you, found out had bacteria causing the pain, doctor gave me 7 days of antibiotics and gaviscon all good... currently doing endoscopy it's like a walk in the park, did some 40 year ago and then it was a completely different story but the process and tools have improved for the better

[sqwakvfr]

14 minutes ago, Sheryl said:

H. Pylori has apparently already been ruled out. And as he is already on heavy duty anti-secretarory meds, pain due to gastritis should have improved yet apparently has not.

 

Ulcer is possible, so is chronic pancreatitis and some other things.

The most accurate test to diagnose an H. Pylori infection is a biopsy from an endoscopy.  A close second is Urea Breath test.  The other methods are an  antigen stool test or a blood test. I was first diagnosed with H. Pylori in 2007.,  It took 6 months before my primary care physician authorized a endoscopy.  Before the endoscopy I was prescribed 3 different kinds of PPI’s.  These PPI’s offered little symptom relief. In the end I was on 2 different kinds of antibiotics and lost 20 pounds. But the H. Pylori was eradicated.  I was also diagnosed with gastritis.  There is no cure for gastritis.  One has to deal with the gastritis attacks when they occur.   Sometimes the attacks can be severe. The GI specialist at CM Ram has  prescribed a new PPI, Dexilant, which offers great symptom relief.  The biggest drawback to Dexilant is the cost(6000 Baht for a one month supply).  

[Badrabbit]

37 minutes ago, Sheryl said:

That in no way suggests reflux.

 

It is also not properly described as "stomach" pain, it is abdominal pain (periumbilical abdominal pain, to be exact).

 

While this region is not near your stomach, sometimes gastritis pain is referred there, however in that the case there should usually have been some symptomatic relief from the meds you are on. Even though gastritis takes time to heal, reduction in gastric acid should lessen the pain. However an active ulcer i nthe stomach or duodenum might still be painful even on meds, and endoscopy is the best way to exclude this.

 

Other possible causes include :

 

Appendicitis, but if it were that your white blood count should be (or become) elevated. How long ago was the blood test? Might be worth repeating it.  Also, should have shown  on CT.

 

Pancreatitis (would be chronic not acute as otherwise you'd be much sicker) - regular CTs can sometimes miss this especially if done early in the disease.  Do you know if serum amylase and lipase were tested (and if so, how long ago?). And how long ago were the CTs?

 

Gall bladder issues (stones, inflammation) can sometimes cause pain in this location but if so would expect to have been visible on CT.

 

A problem with the mesenteric artery causing restricted blood flow - as you are not critically ill, would be of the chronic type. CT will often  miss this , especially if the radiologist was not specifically looking for it.  This is less likely as a cause but can't be totally ruled out as a cause.

 

In terms of what to do, I would suggest proceeding with the endoscopy but to discuss first with the doctor whether it might be wise to make it an endoscopic retrograde cholangiopancreatography (ERCP) which is a type of endoscopy better able to identify chronic inflammation of the pancreas.

 

If this fails you would best come to Bangkok, bringing all test results with you (including the imaging on disk) and see this US-trained, US-board certified doctor who is tops in the field:

 

https://www.bumrungrad.com/en/doctors/Parit-Mekaroonkamol

 

You could also come and see him now, but if he then felt endoscopy was needed, it would cost much more to have it done at Burmungrad than it will at Mission.

 

 

 

 

Thanks but I'm not wealthy, I have to try and do everything as cheap as possible, Mission is all I can afford so will persevere with going there, I've got 2 months of tabs, if not better I will do the endoscopy, I have 1.2 Million Insurance but have to try and pay for myself, using Insurance is only for something life threatening( probably Insurance won't cover something serious so it will be goodbye from me, hopefully that will never happen) yes I wish I had loads of money but like many others I do not have.

[sqwakvfr]

Endoscopy at CM Ram was 17,000 Baht.  It could be higher or lower now. This included the doctors fee, the actual procedure and the lab biopsy.  Last year CM Ram was running a combo Endoscopy/Colonoscopy for 36,000 Baht.  I normally get an Endoscopy every 2 to 3 years and did the Colonoscopy at the same time because it had been about 10 years.  My gastritis condition has to be monitored to see it has gotten worse because it will never get better.  

 

I would at least suggest calling some hospitals in your area and ask what an Endoscopy would cost ?

23 minutes ago, Badrabbit said:

Thanks but I'm not wealthy, I have to try and do everything as cheap as possible, Mission is all I can afford so will persevere with going there, I've got 2 months of tabs, if not better I will do the endoscopy, I have 1.2 Million Insurance but have to try and pay for myself, using Insurance is only for something life threatening( probably Insurance won't cover something serious so it will be goodbye from me, hopefully that will never happen) yes I wish I had loads of money but like many others I do not have.

 

[Pravda]

Be careful with endoscopy and colonoscopy pricing. The prices quoted probably don't include any removal procedures.

[Sheryl]

33 minutes ago, Badrabbit said:

Thanks but I'm not wealthy, I have to try and do everything as cheap as possible, Mission is all I can afford so will persevere with going there, I've got 2 months of tabs, if not better I will do the endoscopy, I have 1.2 Million Insurance but have to try and pay for myself, using Insurance is only for something life threatening( probably Insurance won't cover something serious so it will be goodbye from me, hopefully that will never happen) yes I wish I had loads of money but like many others I do not have.

 

As I explained you would have had immediate reduction in pain with the meds if the problem was reflux (anyhow not consistent with your symptoms) or  gastritis.  Waiting 2 more months is not liely to help and, if there is a serious underlying cause, could be dangerous and lead to much greater expense in the long run.

 

A consultation with Dr. Parit would cost about 1,500 - 2,000 baht max (plus of course airfare). And might well save on unnecessary treatments and tests later as he is quite good at diagnosing difficult cases.  One does not have to be "wealthy" or have "loads of money" to afford that, and most of the people he treats do not fall into such categories. Indeed, it is nto the case that "many" people have "loads of money". I certainly do not. But a 1,500 - 2,000 bill is not that.

 

Be aware that trying to save on health care costs can fall into the "penny-wise, pound foolish" category and end up costing you far, far more. I've seen that unfold many times.

 

What sort of insurance policy covers only things that are "life-threatening" and yet at the same time probably "won't cover anything serious"???? 

 

I assume your insurance is hospitalization only (like most of us, me included) so not immediately relevant (except maybe for the endoscopy, which some insurances would cover as a day surgery). But what you say seems very, very strange. The only 1.2 million baht insurance plan I am familiar with is  Pacific Cross Premier Plan. Nothing in the policy restricts it to life-threatening conditions. And the only circumstance I can envision where they wouldn't cover hospitalization would be if the condition was considered pre-existing.

[Badrabbit]

18 minutes ago, Sheryl said:

 

As I explained you would have had immediate reduction in pain with the meds if the problem was reflux (anyhow not consistent with your symptoms) or  gastritis.  Waiting 2 more months is not liely to help and, if there is a serious underlying cause, could be dangerous and lead to much greater expense in the long run.

 

A consultation with Dr. Parit would cost about 1,500 - 2,000 baht max (plus of course airfare). And might well save on unnecessary treatments and tests later as he is quite good at diagnosing difficult cases.  One does not have to be "wealthy" or have "loads of money" to afford that, and most of the people he treats do not fall into such categories. Indeed, it is nto the case that "many" people have "loads of money". I certainly do not. But a 1,500 - 2,000 bill is not that.

 

Be aware that trying to save on health care costs can fall into the "penny-wise, pound foolish" category and end up costing you far, far more. I've seen that unfold many times.

 

What sort of insurance policy covers only things that are "life-threatening" and yet at the same time probably "won't cover anything serious"???? 

 

I assume your insurance is hospitalization only (like most of us, me included) so not immediately relevant (except maybe for the endoscopy, which some insurances would cover as a day surgery). But what you say seems very, very strange. The only 1.2 million baht insurance plan I am familiar with is  Pacific Cross Premier Plan. Nothing in the policy restricts it to life-threatening conditions. And the only circumstance I can envision where they wouldn't cover hospitalization would be if the condition was considered pre-existing.

Yes Pacific cross, my OPD is only 2500 per day 30 days per year, its very difficult to explain when you are not medically trained, some days I have no pain at all and feel great then it will return but I can control it with Tramadol 50mg.

Looking at a picture of the human body it seems that maybe I don't have Reflux maybe an infection in the large or small intestine.

When this first started approx 6 weeks ago it was so bad it was almost unbearable, it has got much better now, no more burning just intermittent pain, the last few days and nights have been good, my GF is amazing she tells me "fight it you are a strong man" I'm confident it will go soon.

What I meant about Insurance is that I worry if I make a big claim my premium will increase to something I can't afford the following year so I'll continue paying for myself untill something serious happens then I will have no choice but to use it.

[scubascuba3]

52 minutes ago, sqwakvfr said:

 I was also diagnosed with gastritis.  There is no cure for gastritis.  

You sure? i had gastritis managed to stop it, of course if i continued to eat the things that caused it it would come back im sure